Transcription:
Childhood Cancers and Blood Disorders: Information and Treatment


Bill Klaproth (Host): No medical diagnosis is more frightening for a parent than those chilling words that your child has cancer. But there is hope, hope in the form of an ever-new and effective treatment for all manner of childhood cancers, including those of the brain, the blood, and other parts of the body. Dr. Stanley Calderwood, Chief of Pediatric Hematology and Oncology in Saint Peter's Healthcare System in New Brunswick, New Jersey, is an expert in the care of children with cancer. He joins us to talk about some of those latest techniques and the prospects for families confronted by cancer. Dr. Calderwood, thanks so much for being out with us today. So, what are the most common forms of cancer among infants, children, and teens?

Dr. Stanley Calderwood (Guest): You're welcome, Bill. It's a pleasure to be on the show. Childhood cancer is an ever-changing landscape. The most common malignancy we see in childhood is leukemia, which really is a cancer of the blood-forming elements. Over the last several decades, we've had very dramatic improvements in treatments and survival for leukemia so that almost all kids -- in some subsets of leukemia, we're now looking at about 90 percent survival. In kids younger than a year of age, brain tumors are actually even more common than leukemia, and we still have a lot of work to do to cure brain tumors. And throughout childhood, there are various types of solid tumors that we can see—tumors of the kidney, the liver, the nervous system. In adolescence and young adults, we see a lot of lymphoma and bone tumors and muscle tumors. We're making slow but steady progress in all of those fields.

Bill: Are these cancers on the rise, or do you see a decline over time?

Dr. Calderwood: Well, the data from the National Registry suggests that there actually is a slight increase in the incidence of cancer over the last several decades. We don't really know the reasons for that. Some of them are we've identified, for example, that children who have been extremely premature at birth and are now surviving longer, for example, may have a higher risk of certain tumors, like liver tumors. Children who have been exposed to various environmental agents, viruses and so on, are more prone. So it does look like over the course of time there is a slight increase in incidence or occurrence of tumors. On the other hand, treatments are getting dramatically better. So, death rates from childhood cancers have been dropping dramatically. In fact, if you look through, starting about 1960 through the 1990s, a very dramatic annual decrease in the mortality rate in childhood from cancer, 5 percent or 10 percent per year. Unfortunately though, since about 2000, the end of the 1990s, that rate of improvement has dramatically declined. So we're looking at about 2 percent per year decrease in mortality rate from cancer. And so, we have a lot of challenges still to face and a lot of research going on to help us understand what's behind that decline and maybe some new therapies coming down the pipe that will be helpful.

Bill: So you mentioned 90 percent survival rate in leukemia. That sounds like good news to me. It sounds like you're winning the war, to a certain extent.

Dr. Calderwood: Yes. So I think when you look at survival rates in pediatric cancer, starting in around the 1960s and then through the rest of the 1900s, and maybe into the year 2000, the standards of therapy were combinations of surgery, radiation, and chemotherapy. And we've, I think, learned how to use those tools optimally, and those tools are sufficient for curing the majority of children. But there's still 10 percent to 20 percent of kids, and in some disease-types like infant brain tumors are much high percentage where those standard tools are not doing the job. And I don't think that revising chemotherapy protocols or surgery treatments or radiation are going to dramatically improve that. So what we need is new types of therapy, and certainly, there's a lot of things coming online, and we're very excited about the so-called small molecule inhibitors, immunotherapies, and then proton beam as a new type of treatment that may all be helping to get that decline in the annual mortality rate to a level where, hopefully, within the next 10 or 20 years, we're able to offer a cure to almost any child or every child who develops cancer.

Bill: So we hear a lot about proton therapies, speaking of these breakthrough treatments. It has been talked about as a safer, more effective method of battling cancer. Can you tell us what proton therapy is?

Dr. Calderwood: So, protons are charged particles. I think if we start with conventional radiation as a sort of a lead-in point, conventional radiation, you might think of it as something like a laser beam where the beam leaves the gun. It has energy and basically, that declines the farther it goes away from the gun. But if you're aiming at, say for example, a tumor in the middle of the head, there's going to be a certain amount of energy that hits the skin, the skull, the normal brain, in front of the tumor and on the other side of the tumor. And so, there's a lot more collateral damage with radiation. We’ve tried to get around that maybe by, for example, splitting the radiation beam into a number of different beams from different angles that overlap at the tumor. But there's always going to be some surrounding tissue, normal healthy tissue damage. Protons are different. They're more like bombers. So when they leave the airfield, they don't drop their payload or discharge their energy until they get to the target. So the advantage to that is that there is a lot less collateral damage. We're getting very tight fields around the tumor so that the healthy structures in front of and behind the tumor are not exposed to quite as much damaging energy.

Bill: So you're really able to really pinpoint the tumor with proton therapy.

Dr. Calderwood: Pinpoint the tumor and target the tumor, specifically. So it's not like the tumor is in the path of the radiation beam, but the tumor is actually the target of the proton particle beam. So I think what we're finding, especially in younger children, and especially in children who have brain tumors, where the damage from conventional radiation has sometimes been unacceptable and has not allowed us to use that modality or that form of treatment than with the proton beam radiation, we're able to use that form of treatment in younger children and spare vital surrounding structures—so, less impact on their growth and development, less impact on their hearing and school performance and things of that nature.

Bill: Certainly a worthwhile breakthrough. It sounds like an important developing tool in the war against cancer. And doctor, can you talk about the physical effects of cancer treatment? So we're talking about treatments and what sort of therapies are recommended and available to ease the physical ill effects of the cancer treatments.

Dr. Calderwood: Yes. So I think we can think of the side effects of treatment as being those that children experience immediately and things that can occur much later on in life, the sort of late effects of the treatment. The immediate side effects are the things that most people are very well aware of—the hair loss, the nausea and vomiting, the mouth sores, changes on the skin, decreased blood counts so there's a need for transfusion and platelet support, and an increased risk of infection. So we have been using chemotherapy for three or four decades now. So we've gotten very good at controlling those side effects. There's a very good antiemetic medications that can prevent nausea and vomiting in most children. There are growth factors that help the marrow to recover and reduce the risk of infection. There's blood and platelet transfusion and other forms of supportive care that really make chemotherapy much more tolerable. So the misery that kids go through during the course of their treatment is now substantially reduced from where it was even a decade ago.

Bill: Very good news. Excellent. And so, let's talk about the mental effects of cancer. Cancer is traumatic for anyone, but I would imagine it's especially traumatic for children. Are there cancer support groups available for kids and their parents?

Dr. Calderwood: Yes. I think trying to imagine the impact of a diagnosis of cancer on a child is very difficult. There's a loss of autonomy. There's the change in body image with hair loss and mouth sores and nausea and vomiting. There's isolation from peer groups. Parents and doctors, they're appropriately concerned about things like increased infection risk, so kids often end up isolated and out of school and out of their usual activities. And it's really just devastating. And a child impacts on the whole family; the whole family structure has to change. Maybe mom or dad needs to start taking time off work to be with the child. And it impacts the whole community. That family is part of a community; the community is touched with the cancer, and schools and parents of the schools become concerned because their child gets this if they come in contact. So there's a whole range of psychosocial impacts that are very hard to gauge. So I personally think that every child who is diagnosed with cancer needs to be evaluated by a psychosocial supportive care and counseling team. At Saint Peter's, we have a program called New Vision, which is headed by our clinical social worker, Irena Mariano Brown. So we do an evaluation in all children. And families have different coping skills. They have different abilities to adapt to situations. So some just need a little touch base, and is everything fine, is there anything we can do, and other families need a great deal more support and intervention. And I think we try very hard to address that whole dynamic that the child and the family are going through.

Bill: So there is support and support groups, and it's something you would recommend depending on the level of care or treatment the family may need. Dr. Calderwood, go ahead.

Dr. Calderwood: What I was going to say is I believe that most pediatric oncology centers have that sort of written in. At Saint Peter's, we have a program called New Visions, which really tries to emphasize those psychosocial aspects of the care of a child with cancer, which are really critical to adaptation and cure—and ultimately, happiness and adjustment to society. And those are the things that we really have to be concerned about.

Bill: Dr. Calderwood, last question. What's your best advice, then, for a parent who has a child with cancer?

Dr. Calderwood: My best advice is if you don't understand what's going on, make sure you pin your doctor down and talk with them and talk until you do understand what's going on. And your child, no matter what they're expressing, is going to be experiencing some upset, and probably having your child at least talk with social workers, psychologists, make sure that they have an opportunity to deal with the grief and stress that they're going through with the loss of autonomy, removal from the usual roles, you just can't overestimate the impact of those things on a child. The help is there. Get it if you need it.

Bill: Absolutely. Dr. Calderwood, thank you so much. I can't imagine any more heartbreaking than having to have a child with cancer. And luckily, we have people like you on the case to help us through it. So thank you so much for your time today. For more information, please visit saintpetershcs.com. That's saintpetershcs.com. I'm Bill Klaprock. This is Saint Peter's Better Health Update. Thanks for listening.